The Invisibility of the Multiply Stigmatized Patient: Intersections of Ethnic Prejudice and Stigma of Chronic Disease in Medical Students.

Abstract

Ethnic prejudice in healthcare has been widely examined, yet little is known about its intersection with stigma and prejudice based on one's health status. The present study investigates the intersections of ethnic prejudice and stigma of chronic disease in a healthcare setting as shaping unique forms of disadvantage. From an intersectional perspective, we examined whether ethnically diverse patients affected by stigmatized health conditions would be differentially perceived and cared for by prospective medical doctors. In a within-subjects, experimental design, preclinical medical students read, and evaluated clinical vignettes describing patients, who were presented as either White Italian or Middle Eastern migrants and were affected by visible and concealable stigmatized chronic conditions. Emotional reactions, attributions about disease-onset, caretaking attitudes, and meta-beliefs about patient disclosure behavior were assessed. Results showed that when reading of patients affected by visible compared to concealable stigmatized conditions medical students experienced stigma-related emotions (e.g., disgust, pity, fear) and attributed patients a higher tendency to be embarrassed, to hide, and to avoid disclosure for fear of others' negative reactions. However, Middle Eastern migrants when affected by conditions with visible and behavioral manifestations were attributed a lesser tendency to feel embarrassed, to hide, and to avoid illness disclosure for fear of others' negative reactions compared to White Italian patients with the same conditions. These findings indicate that at the intersection of ethnic prejudice and health-related stigma, multiply stigmatized patients may become invisible and not fully considered in the eyes of medical students. Present results underscore the need to enhance diversity representation in higher medical education for a more inclusive healthcare curriculum and practice.